Drilling seems to be the root of the problem.January 4, 2012 12:45 PMSubscribe

Was my co-worker the victim of a bad dental procedure? How should she proceed now she needs more expensive work done?

A co-worker of mine recently went to a new dentist for a cleaning and was told she needed several fillings. She has generally healthy teeth (some gum issues, has had fillings before) and was surprised, but had some of the work done (he drilled and filled 4 teeth). She had to go back the next day and have fillings sanded down. A week later, her teeth are still sore and have become cold-sensitive. Returning again, her dentist told her that she had nerve damage and would need a root canal (possibly more than one). Prior to the initial visit, her teeth weren't bothering her at all.

Obviously, she needs to get a second opinion (and to wait a bit longer), but it sounds like the root canal may well be necessary. Having had a root canal myself, her symptoms sound almost identical. She's already looking in to getting a copy of her original x-rays and making an appointment with another practice.

Operating on the supposition that her dentist damaged her teeth while doing the fillings, how should she proceed? She is in eastern Massachusetts and has reasonable dental insurance.

Ideally, given cost or time is not an issue, the first two steps to take in any sort of possible medical malpractice is to:

#1 - Document everything related up to that point and everything related moving forward.
#2 - Contact a lawyer seeking legal advice on how to proceed.

If you have absolutely no interest in going down the legal avenue, I would then recommend documenting everything and contacting your insurance company and possibly the dentist's office.posted by seppyk at 12:59 PM on January 4, 2012

I am not a dentist or a lawyer, but I get a lot of fillings. Sore and cold-sensitive teeth can be signs of an incomplete filling.posted by muddgirl at 1:05 PM on January 4, 2012

I just had some fillings done and my dentist told me that the cold-sensitive thing could take a couple weeks to go away. (Just as a data point.)posted by sperose at 1:24 PM on January 4, 2012 [1 favorite]

Anecdata:

I had a deep filling sometime in October. It was a small cavity, but it was between two molars and it took quite a bit of drilling. The dentist warned me that I could be "sensitive" to temperature for a bit.

I was in pretty excruciating pain on that side of my mouth for, oh, a good solid month. Friends warned me that this could happen, so I didn't worry too much about it, but it was incredibly exasperating to have gone in with no tooth pain, had work done, and come out with pain that kept me up at night. It did die down gradually and completely disappeared by the end of December.

Get a second opinion, she may not need the root canal (but she almost definitely needs a new dentist).posted by lydhre at 1:28 PM on January 4, 2012

Returning again, her dentist told her that she had nerve damage and would need a root canal (possibly more than one).

I'm usually not one to argue for lawyering up against health professionals, but from what you're describing, I think your friend should at least give thought to consulting a lawyer.

It's a big leap from "you need a filling" to "you're going to need a root canal." That's like breaking your arm and, after the cast is put on, being told you need an amputation.

A root canal is an awful thing. I'm sure you know this, but it's basically killing the tooth and packing its dead husk with stuff and hoping the dead tooth stays intact for the rest of your life. The tooth becomes brittle, can crack, break, or get infected, and can cause major problems. (I'm at the tail end of an implant procedure to fix a root canal gone wrong.)posted by jayder at 1:46 PM on January 4, 2012 [1 favorite]

Nthing that pain can linger for a while, and then disappear. She should wait before deciding on a root canal.

When you have a deep cavity, sometimes it's a crap shoot as to whether the filling is going to work or not, and it's possible that drilling and cleaning out the cavity irritated the nerve. This happened to me - it was worth it to try to fill the cavity rather than immediately proceeding to a root canal, but the filling didn't work, and I ended up getting the root canal.

I am not and never will be a dentist. I have managed a dental office and I am the proud owner of several very deep fillings.

Here are some things about teeth that folks generally don't know.

First, radiographs (xrays) show a lot, but not everything. So, often, what looks on film like a teeny weeny bitty baby filling turns out to be an enormous monster filling which requires a root canal. Other times (if you're lucky) the spot on the film looks forboding, but the doc gets in there and it just needs a bit of filling. Diagnostic methods are not perfect, and either of these happens about as often as perfection seems to.

Second, teeth are weird. They don't especially appreciate being banged on and jostled. They get over it eventually, but some take longer than others. Some folks' teeth don't care one way or the other. My teeth, on the other hand, remain incredibly sensitive to cold for months after a filling. Months! It baffles everyone who goes near my face. I have terrible genetic british teeth and constantly live in fear that my choppers are going to just abdicate altogether.posted by bilabial at 1:59 PM on January 4, 2012 [2 favorites]

I'm seconding chocolatepeanutbuttercup. When I had a deep cavity filled, it lasted about two months before I had to have a root canal/crown. (The pain was so severe at that point, I couldn't do anything but get the tooth taken care of; sleeping, working, and talking were all out of the question.) The tooth didn't hurt at all before my first trip to the dentist. However, my dentist warned me about the possibility of the filling going south when she did it.

Definitely get a new dentist!posted by Kronur at 1:59 PM on January 4, 2012

It's a big leap from "you need a filling" to "you're going to need a root canal." That's like breaking your arm and, after the cast is put on, being told you need an amputation.

FWIW, this has actually happened to me more than once. My dentist (whom I trust very much) says that some people's teeth are like that--relatively minor work can trigger them to "act up" so badly that a root canal is needed. My dentist takes this tendency into account when deciding whether to recommend work to me.

A second opinion is a good idea, but based on my experience I wouldn't assume that being told a root canal is needed after getting fillings means someone did a bad job, or was somehow shady.posted by not that girl at 2:40 PM on January 4, 2012

If it were really the case that there was a reasonable possibility of your coworker needing a root canal after the filling, the dentist should have mentioned that, and should have allowed your coworker to make the decision about whether she was ok with the risk or not.

However, my initial take about your post, before reading other responses, was that this dentist did a bad job on the actual work. For one thing, you mention that the coworker was "surprised". She knows her own teeth, and something was a bit off about the work she was told she needed, but she quashed her own feelings about it and went ahead. That is an important data point, in my opinion.

Second, the dentist actually told her she had "nerve damage". Not that her teeth would just be cold-sensitive for a while. And, what a coincidence, she should have more work to fix what he caused in the first place.

A dentist once told me that cavities are, to a certain extent, a matter of opinion. What one dentist considers a cavity, another will not. This dentist also said that unscrupulous dentists, or dentists struggling in s bad economy, are more likely to call things cavities that really aren't.posted by jayder at 5:55 PM on January 4, 2012 [1 favorite]

Not addressing whether the fillings were necessary, because it doesn't matter at this moment. For the work that was already done: She has already had miscommunication, fillings that were high, needing to be adjusted the next day, and the sensitivity.

Like Bilabial said, every person's tolerance for sensitivity is different, I see patients with huge, bombed out teeth. We restore with ginormous fillings and they go merrily with nary a twinge. And some minor, tiny fillings are agonizing for weeks after before settling down. Dentists cannot know how a tooth is going to feel afterwards, but they can set expectations for their patients.

What I would do is make certain that my bite felt correct, that the fillings are not being banged on by being too high. If I feel like the bite is right, then I'd get a tube of sensodyne or colgate sensitive toothpaste but it has to have potassium nitrate in it. I'd get a glop on my finger and rub it into my affected teeth and let the glob soak in several times a day. I'd give the tooth a break by keeping my food/drinks at mild temperatures. Take ibuprofen if needed. Give it time! Cold sensitivity is a symptom that can reverse and doesn't automatically mean root canal. And BTW, root canals aren't the worst thing in the world, maybe a pain in the wallet more than anything. But yes, a crown would be needed asap to prevent fracturing.

If the bite still wasn't correct, I'd let the same doctor adjust them, unless all trust is broken and don't want to deal with him anymore. The doctor may also put a resin sealer or fluoride varnish treatment to help with sensitivity.

Patients have the right to copies of their xrays and treatment history, so your friend can request them and have another dentist check her out. She should get personal recommendations and not rely on insurance website or phone book.posted by Jazz Hands at 6:05 PM on January 4, 2012

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